Psychological Issues Post Cardiac Surgery

Hi there physiocrew,

My cardio placement was in December and when I first started working with patients that had just arrived on the ward after having coronary bypass surgery, my biggest concern was with how each patient would react physiologically to transferring out bed and attempting to take a few steps for the first time. Thus my attention was solely focused on organising their attachments, monitoring their chest status and response to ambulation.

However what I failed to monitor or give adequate thought to during my initial two weeks was the patient’s mental or emotional well being since coming out of the operating theatre. Around the end of my second week, I started noticing that patients were fairly upbeat when I was with them providing treatment. But when I was walking by their room I noticed that the majority of the coronary bypass patients were sitting in their chair, not talking to anybody, usually staring off in the room or with their head down, some a bit tearful. There was an obvious pattern emerging and some further investigation was required.

Looking at studies in the some of the databases, a lot of research has been done on the psychological issues that post cardiac surgery patients encounter. The majority of papers stated that upon assessment of pre and post surgery levels of issues such as depression and anxiety, a measurable decrease in emotional and mental status was evident post surgery, and these decreases were seen as much as six months down the track. Further research into the mechanisms responsible for this onset of psychological issues varied from ischemic cerebral events to a disruption in circadian rhythms of certain hormones as a result of going on-pump during surgery.

All this was fairly interesting but the main result from doing a little reading into the topic was that I found myself more aware of these types of issues for patients on the ward during the final two weeks of the placement. My increased awareness resulted in the addition of more education for my patients during the treatment sessions, such as providing more time for reassurance and explaining to the patient what the next 6 weeks would involve for them. By diverting more attention to the potential for psychological issues to arise, I think my treatments session actually became more effective for the patient. However, I also noticed a need to increase and develop the number of strategies in my arsenal to address these types of patient issues as I found myself a little limited in this regard.

If anyone has also seen this pattern with their patients post surgery then please feel free to provide any ideas or strategies that you used to address these issues with this population.

Thanks
Gareth